PMT15-01766 City of Menifee Permit No.: PMT15-01766
29714 HAUN RD.
/% ", MENIFEE, CA 92586 Type: Residential Electrical
c� usMm�a MENIFEE Date Issued: 06/25/2015
PERMIT
Site Address: 31221 SADDLEBACK LN, MENIFEE, CA Parcel Number: 360-210-016
92584 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of EXISTING ELECTRICAL PANEL UPGRADE TO 225 AMPS FOR SOLAR PERMIT PMT15-00872
Work:
Owner Contractor
SUZANNE MALDONADO SMITH ELECTRICAL CONTRACTORS INC
31221 SADDLEBACK LN 8733 N MAGNOLIA AVE 112
MENIFEE, CA 92584 SANTEE, CA 92071
Applicant Phone: 6197589829
EMILY FORSTER License Number: 871200
SMITH ELECTRICAL CONTRACTORS INC
8733 N MAGNOLIA AVE 112
SANTEE, CA 92071
Fee Description ON Amount($1
Building Permit Issuance 1 27.00
$144.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee. Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months, shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class C- 10 License No. 0 who builds or improves thereon, and who contracts for the projects with a
Expires I j l0 Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam exempt from licensure under the Co^'r_aors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I ackr .,ied— ;oat, excer' " Dersonal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have r .,.,ed Ix at least one year prior io comoletion Of
Section 3700 of the Labor Code, for the performance of work for which this improvements -.,,ere' by mis permit, I cannot legally sell a stmctwo . - '
permit is issued. hi 10' ,,,i o Omlding if it has not been constructed in its entirety by licenseu
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of th,
)W I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto//www.Ieqinfo.caoov/caIawhtm1.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier EV2res+ Na-honal ns . Co . Property Owner or Authorized Agent Date
Expires I0/23/l S Policy#7(SV000 10140 131
❑ By my Signature below, 1 certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the i s coon purposes.
shall not compensation
any persons in any manner so r to become subject to the r . y ..
workers'compensation laws of California, and agree that if I should become (�y/��Y
subject to the workers'compensation provisions of Section 3700 of the Labor Property Ow er orA orized Agent Date
Code, I shall forthwith comply with those provisions. 'p 00.77614f
07/ q City Business License# ✓ !� f
Date; (D Z5/IS Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY 7` SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT -
Lender's Address 'ONO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, '6NO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's Stale License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or WES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPOR"t'ING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; �y,Y)ti11nK,/,
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property, '
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
Ckien% affficafibn
DATE 5b S PERMIT/PLAN CHECK NUMBER I1 — (-Iwo
TYPE: O COMMERCIAL ,x RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION — DEMOLITION 3 ELECTRICAL O MECHANICAL
O NEW ' PLUMBING 3 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK EXISTING ELECTRICAL PANEL UPGRADE TO 7ZSAMPS
450(0.4- PMTps -oog
PROJECT ADDRESS 3122. Sq l-e oc Ln. Sl,{. ) btU CA IZ2-1
j ASSESSOR'S PARCEL NUMBER �WI _ p110'0I0 LOT TRACT
u OWNERNAME aJ U{ OnedO
ADDRESS 3) 2,1 ) Sa eba Ln . S n bly on qz!a4
PHONE 9'�Tk 123- 1 Jr6 3 EMAIL
APPLICANT NAME SMITH ELECTRICAL CONTRACTORS,INC
ADDRESS 206 GREENFIELD DR#G,EL CAJON,CA 92020
PHONE 619-758-9829 X101 EMAIL pe"itupdates@smithelectricsd.com
CONTRACTOR'S NAME SMITH ELECTRICAL CONTRACTORS, INC OWNER BUILDER? O YES O NO
I
i
BUSINESS NAME SAME �.
ADDRESS SAME AS ABOVE
PHONE SAME EMAIL SAME
CONTRACTOR'S STATE LIC NUMBER 871200 LICENSE CLASSIFICATION C-10
VALUATION$ 1400.00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU51NE $LICF[JS_E/IUMBER
BUILDING PLANNING ENGINEERING FIRE GREENIto SMIP 3 /p_�IS
INVOICE PAID AMOUNT
AMOUNT I "-'CASH 'CHECK# G CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH %CHECK# -CREDITCARD VISA/MC
OWNER BUILDER VERIFIED Q YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Sofety Deportment 29714 Houn Rd. Menifee, C4 92586951-672-6777
www.cityofinenifee.us Inspection Request Lint,951-246-6213